Did I get fobbed off at A&E?

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I went to the doctor the other day. She took my heart rate and said my erratic heart rate was alarming. It was jumping from 95, to 75, to 85, back up to 95, all within 30 seconds.
She booked me in for an ECG in a couple of weeks time but told me to go to A&E if I get pains and/or fluttering. She said it was worrying.

Last night I did indeed feel fluttering and had palpitations constantly so I went today. My heart rate was again ranging from 98 to 78.

I had an ECG done.
It said “sinus rhythm normal, possible left atrium enlargement, ECG borderline”.
This panicked me.

But when I went into the next room with the consultant, he asked me how old I was. When I said 27F, he said “ah okay, it’s all fine then”. He said my fluttering is “perfectly normal” and my ecg is “100% fine”.
I asked him why it said borderline, why my heart rate is so erratic and why I’m getting flutters then; and he just said not to worry and sent me home?

Am I missing something? I’ve never had an ECG so I don’t know what’s normal?

I'm not a medical expert so can't advise on that side of things.

However, absolutely go back if you get more fluttering/palpitations or other symptoms. Better safe than sorry!

you sound genuinely concerned, it’s your heart so I’d probably ask your GP for a second opinion.

I just don’t know if it’s normal for the sheet to say “ecg borderline” or “possible left atrium enlargement”!

Im sitting down stationary right now and I reckon my heart rate is close to 100!!

Surely your GP should have referred you to a cardiologist if she found it so worrying.

The machines are programmed to report on the ECG but they are useless at reporting and haven't seemed to get better in 20 years.

Professionals are trained to always ignore the report the machine gives you.

Plus the issue you went with was palpitations, they checked while you thought you were having a palpitation but your heart rhythm was normal.

A+E are only going to look at emergencies, they showed you weren't having and emergency and so sent you home.

Not fobbed off for a&e at all no, as you are not acutely unwell. Having an enlarged heart doesn’t generally cause any problems but can increase risk for a heart attack. However, as a young woman you are otherwise extremely low risk, especially if you are a non smoker. Keep an eye on it and keep referring yourself back to the GP if the issues carry on, heart palpitations can be due to anxiety, caffeine etc. I would keep asking for monitoring as you age but it’s unlikely to be a problem in the short term.

There isn't any evidence of an enlarged heart though, just an automated ECG report which nobody would ever rely on.

Ahh ok, honestly was just wondering because I don’t really know how ECG reports work. Thank you!

A&E is for emergencies, and the doctor there obviously thought yours wasn't an emergency. Just because your ECG said something, doesn't mean what it said was an urgent or immediate problem. I'm not a doctor so I can't interpret it, but I'd trust the doctor knew what it meant.

I'd go back to GP, they may want to refer you to cardiology.

What’s the point of an ECG if the reports are ignored? Serious question as I’ve had abnormal ECGs which docs have said are perfectly normal.

The automatic ECG reports are inaccurate. They asked for your age as ECGs look different depending on age and you need to view it in context.

Your heart rate is within normal range. It varying by 10 bpm isn’t clinically significant on its own. I think it would be appropriate to discuss with your GP again if it’s still causing you concern.

Ignore the machine/computerised report on the sheet - it means nothing. It can suggest a heart attack when it’s perfectly normal.

The point of the ECG is that a doctor looks and interprets it. It’s why google isn’t medicine yet.

I have atrial tachycardia - where the heart rhythm just goes completely erratic and your heart is racing but can't beat properly. With that, your heart rate is 150+.

78-98 is quite a normal heart rate range, although I know it's not beating normally, but just trying to reassure you that it sounds like very mild palpitations. Your heart rate varies a lot even with just normal walking about so the speed in itself doesn't seem terrible.

as everyone else has said, trust that the doctor knows what they are doing BUT don't be afraid to go back if it's continuing or getting worse.

Yes but what’s the point of an ECG then?

Don’t follow what the written blurb on the ecg. It can sometimes be artefact or a lead issue. The actual ECG itself is read by the clinician. However, if symptoms persist you could maybe do with a 24 monitor which your GP can refer you for.
The rate itself does not sound alarming.

A&E have concluded that it's not life threatening. You have been referred for Cardiology by your Dr so they will be able to answer more of your questions. You could just have palpitations or a condition called SVT (which can cause fluttering or a very fast heart rate). It can be a bit of a nuisance, but is generally not life threatening. If you do have any symptoms of a rhythm problem (either SVT or an Arrythmia), there are loads of treatment issues (from doing nothing, to occasional medication, daily meds or a procedure called an ablation). I had one 4 weeks ago. It has a 95% success rate and was performed under local anaesthetic as a day case. I understand your anxiety, having had similar heart issues, but there is so much that they can do today, so even if you do need some treatment, it's unlikely to be a problem. I think that the uncertainty is worse and going to A&E with a heart issue is always going to be unsettling, even if it's all ok.

I have atrial fibrillation and aim to keep my heart rate at 100 or below with various meds - when it gets to 150 I start ringing 111.

It does not sound as though there was anything very serious going on for you, although I absolutely understand that anything not feeling right with your heart can be very scary. I think it might help for you to make an appointment with your GP - good luck with that! - and go through your concerns so that you can get some reassurance and explanation of what happened.

If it's any consolation my heart rate would suddenly jump from 70/80 to 220 and last for several hours. I was still told that I could choose whether i wanted any treatment or not.

the point of an ECG is that it tells you about the electrical activity in the heart and from that you can diagnose/exclude a whole bunch of problems including unusual heart rhythms, abnormal anatomy, compromised blood flow, electrolyte abnormalities, and a billion other things. ECGs need interpreting by someone with experience and the medical history +/- other test results. The print out a the top is generated by the machine, which doesn't know the medical history/other results. The print out is useful for identifying some things, but is often comically wrong. That's why you still need HCPs with experience/training and who can correlate the electrical info with everything else in front of them.

If you are anxious, which is pretty much a given in the situation you describe!, a perfectly normal heart can start having mild arrhythmias - ectopic beats, palpitations, and exaggerated respiratory sinus arrhythmia, which is totally benign - where your heart rate speeds up and slows down in time with your breathing. If I’m heading for a panic attack my heart rate will veer from 70 to 100 in time with my breathing - it’s basically your anxiety doing a number on your vagus nerve, which controls your heart rate. In a normal heart, none of this is a problem. As others have said, the auto suggestions on the ecg machine are bonkers. I’ve never had a normal one, and on review, experienced doctors are always fine with it. (My GP once took seriously its suggestion that I had Wolff Parkinson something syndrome, which sent me into a complete panic, but again, on review nothing to worry about!). By all means book in with your GP again; you could ask for an echocardiogram just to confirm there is nothing structurally wrong, but A&e wouldn’t have discharged you with a serious heart issue. For the palpitations, you can try a banana, a magnesium supplement and keeping really well hydrated and trying to relax - it really does help!

I’d go to the GP and ask for an explanation, they may refer you to a cardiologist for further investigation. I’d definitely book to see my GP as I wouldn’t be satisfied with being told everything is fine when the report mentions a potential issue. I’d want a better explanation

Go back to your gp and ask for a 48 hour Holter monitor test. This will show your heart activity over a longer period, which will give a better view of what is happening to your heart, though they aren’t conclusive. I was diagnosed some years ago with an irregular pulse and erratic heart rhythms, and after further investigations - first a Holter test and then with an implanted loop recorder because the Holter wasn’t picking up enough information - I was eventually put on blood thinners and given a pacemaker.

Thanks, that is helpful.

Keep pursuing with the GP. I had an ECG at the surgery which picked up atrial fibrillation, but the one the consultant did picked up nothing. I'm just very glad it was that way round, because otherwise I wouldn't have got to the consultant. The consultant put me on a 14 day monitor, and it turned out I was fibrillating about a third of the time (without me being aware); I've now had an operation which has hopefully worked.

It sounds as if you still have an ECG booked with the GP, so next step is that. If you have any idea of any triggers, try them before the ECG (when I had my third ECG, I walked up and down stairs a few times just before the appointment) so that there is a higher chance of it being picked up.

I hate it when doctors do this - a little communication would go a long way. If he had actually explained why he wasn’t worried in a couple of sentences, you’d probably be feeling a lot more reassured. Do go back to your GP if you’re still getting symptoms. I think A&E doctors are always pretty rushed and blunt and focussed on just filtering out the emergencies, by necessity.